Sympathectomy versus Sympathicotomy in Palmar Hyperhidrosis Comparing T3 Ablation.

OBJECTIVE: The objective of this study was to evaluate and compare thoracoscopic sympathectomy and sympathicotomy at the third ganglia (T3) level for the treatment of primary palmar hyperhidrosis in terms of initial surgery results, complications, and patient satisfaction. MATERIALS AND METHODS: Two groups of patient underwent T3 thoracoscopic sympathectomy and thoracoscopic sympathicotomy under general anesthesia using single-lung ventilation via a double-lumen endotracheal tube by the same surgical team for the treatment of severe primary palmar hyperhidrosis or a combination of levels for multiarea between 2008 and 2013. The groups were homogeneous for relevant demographic, physiological, and clinical data. All patients were examined preoperatively and were followed up at 6 months postoperatively. In both groups, patient's satisfaction was evaluated 6 months after surgery by a detailed interview and scored into three grades (1 = very satisfied, 2 = satisfied, and 3 = dissatisfied). RESULTS: No operative mortality, major intraoperative complication, infections, and Horner syndrome were recorded. There was no treatment failure. The average time of operation was 50 minutes for Group A (sympathectomy) and 36 minutes for Group B (sympathicotomy). Compensatory sweating occurred in 40 patients (89% for Group A and 85.11% for Group B) with a different accumulation of the severity degree. The satisfaction rate was 91.11% for Group A and 93.61% for Group B. CONCLUSION: There was no significant difference between thoracoscopic sympathectomy and sympathicotomy at the third ganglia (T3) level for the treatment of primary palmar hyperhidrosis in terms of initial surgery results, complications, and patient satisfaction. Neither surgical technique is better than the other one for palmar hyperhidrosis treatment. Development of severe compensatory sweating and postoperative pain are major determinant factors of patient dissatisfaction. Sympathicotomy should be preferred for palmar hyperhidrosis treatment, as it is much technically shorter, simpler to implement, and also easier to learn.

Echocardiographic assessment of right ventricular function before and after surgery in patients with pectus excavatum and right ventricular compression.

BACKGROUND: We aimed to evaluate the effect of surgical repair on right ventricular (RV) function in patients with pectus excavatum (PE) and RV compression by Doppler echocardiography. MATERIALS AND METHODS: Twenty-three patients who were admitted to our hospital for surgical correction of PE between 2009 and 2012 were included in the study. After transthoracic echocardiographic evaluation, 16 patients with RV compression were enrolled. All patients were males (100%) with a mean age of 20.5 ± 5.6 years. Transthoracic echocardiography was repeated 1 month after surgery. Echocardiographic evaluation included the assessment of RV diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), pulsed tissue Doppler systolic velocity (S'), RV isovolumic acceleration (RV IVA), systolic pulmonary artery pressure, left ventricular (LV) ejection fraction, and myocardial performance indexes of both the right and the left ventricles (Tei index). RESULTS: Following the surgery, the RV end-diastolic diameter, TAPSE, S', and RV IVA were found to be significantly increased in patients with PE. In addition, RV and LV Tei index significantly improved after surgical correction. CONCLUSIONS: RV function significantly improved after corrective surgery. Quantitative echocardiographic examination provides accurate estimation when deciding for corrective surgery and also should be used in the assessment of postoperative improvement.

[Esophageal foreign bodies in children and adults: 20 years experience]. / Çocuklarda ve eriskinlerde özofagus yabanci cisimleri: 20 yillik deneyim.

BACKGROUND: Esophageal foreign object ingestion is frequently seen in all ages. Failure to treat can cause serious complications such as esophageal perforation. The aims of this study were to characterize the clinical features related to foreign objects in the esophagus and to analyze the results of commonly used methods for their removal. METHODS: We analyzed 20 years of records from Siyami Ersek Hospital, Istanbul and identified 512 cases of foreign objects enlodged in the esophagus. RESULTS: In pediatric patients, the majority were aged between 2-5 years (34.4%), while in adult patients, the majority were above 55 years (38.7%). Coins were the most common foreign object detected in children (68.8%), whereas meat impaction was most common in adults (87.4%). The most common location of the foreign object was the cervical esophagus in children (78.2%), and the thoracic esophagus in adults (66.4%). In 30.8% of adults, there was esophageal or systemic disease. Objects were removed with a Magill clamp in 48.3% of children. Rigid endoscopy was the main treatment in adult patients. Perforation due to endoscopy developed in three patients. Surgical repair was performed on these patients but all died due to mediastinitis. CONCLUSION: Underlying esophageal or systemic diseases may predispose adults to foreign object ingestion in the esophagus. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years.

EBUS ROSE-guided cytological evaluations of intrathoracic lesions. Assessments of the pathological material adequacy and the diagnostic efficacy.

BACKGROUND: Several clinical groups consider cytological assessment under EBUS (Endobronchial Ultrasonography)-ROSE (Rapid Onsite Evaluation) as the golden standard for diagnosis and staging of intrathoracic lesions. On the other hand, some investigators proposed that EBUS-TBNA (Transbronchial Needle Aspiration) has considerably high false-negative rates for diagnosis. In this study, we analyzed our patient cohort (n = 152) with intrathoracic lesions and suspected malignancies evaluated by EBUS-ROSE. Our specific aims were: (i) to determine whether EBUS-ROSE could provide sufficient pathologic material for diagnosis and staging; (ii) to determine the fidelity of EBUS-ROSE-guided initial diagnoses in comparison to paraffin block diagnoses; (iii) to evaluate whether anatomical localization of sampled lymph nodes associate with material adequacy and final diagnoses. METHODS: NCSS (Number Cruncher Statistical System) 2020 Statistical Software (Utah, USA) was used for statistical analysis. RESULTS: In EBUS-ROSE cytological assessment, material adequacy was determined in 50,7% (n = 77) of the cases. Considering the paraffin block pathology as the golden standart, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates of EBUS-ROSE were 90,2%, 93,1%, 94,8%, 87,1%, and 91,4%, respectively. There was no statistically significant difference between the final pathology and EBUS cytology results (p > .05) with a non-random Kappa agreement rate as 82.9%. There were differences in material adequacy and diagnoses according to the localization of sampled lymph node stations. CONCLUSIONS: EBUS-ROSE is efficient to decide for the adequacy of the pathological specimen and provides diagnoses with reliable fidelity.

Could cytology supplant frozen section for intraoperative evaluation of thoracic lesions? A single institutional experience in a developing country.

BACKGROUND: The diagnostic performance of cytology was compared with the frozen results and its usability was evaluated as a rapid diagnosis method in intraoperative thoracic surgery in a single institution (Istanbul, Turkey). METHODS: All 197 subsequent patient specimens (cases) from 158 patients who were sent to our department from the thoracic surgery clinic for an intraoperative diagnosis request between the years 2016 and 2021 were evaluated. Obtained results from frozen and cytology were compared with final paraffin section diagnoses. Lesions were grouped into three different groups as nonneoplastic, benign, and malignant neoplasms. RESULTS: Diagnostic accuracy values of cytology and frozen sections in intraoperative consultation were 98.8% and 99.4%, respectively. Sensitivity values of cytology and frozen sections in intraoperative consultation were 96.3% and 98.7%, respectively. Specificity values of cytology and frozen sections in intraoperative consultation were 100% and 100%, respectively. Negative predictive values of cytology and frozen sections in intraoperative consultation were 96.7% and 98.9%, respectively. Positive predictive values of cytology and frozen sections in intraoperative consultation were 100% and 100%, respectively. Kappa statistics between cytology and frozen revealed a very high interrater reliability (Cohen's Kappa value: 0.911; p = .001; p < .01). The difficulty in distinguishing primary and metastatic carcinoma, which is mostly undecided in frozen sections and the definitive diagnosis is left to paraffin sections, seems also be a problem in the cytological examination. CONCLUSIONS: Cytological diagnosis can be used in the evaluation of small biopsy specimens that require tissue preservation in intraoperative consultation, especially for immunohistochemical and advanced genetic studies.

Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients.

BACKGROUND: Surgical drainage is a rapid and effective treatment for pericardial tamponade in cancer patients. We aimed to investigate the effectiveness of pericardial window formation via mini-thoracotomy for treating pericardial tamponade in cancer patients, and to evaluate clinical factors affecting long-term survival. METHODS: Records of 53 cancer patients with pericardial tamponade treated by pericardial window formation between 2002 and 2008 were examined. Five patients were excluded due to insufficient data. Kaplan-Meier and Cox regression analysis were used for analysis. RESULTS: Forty-eight patients (64.7% male), with a mean age of 55.20 ± 12.97 years were included. Patients were followed up until the last control visit or death. There was no surgery-related mortality and the 30-day mortality rate was 8.33%; all died during postoperative hospitalization. Morbidity rate was 18.75%. Symptomatic recurrence rate was 2.08%. Cancer type and nature of the pericardial effusion were the major factors determining long-term survival (P <0.001 and P <0.004, respectively).Overall median survival was 10.41 ± 1.79 months. One- and 2-year survival rates were 45 ± 7% and 18 ± 5%, respectively. CONCLUSION: Pericardial window creation via minithoracotomy was proven to be a safe and effective approach in surgical treatment of pericardial tamponade in cancer patients. Cancer type and nature of pericardial effusion were the main factors affecting long-term survival.

A comparative in vitro study of frictional resistance between lingual brackets and stainless steel archwires.

Friction between archwires and labial brackets has received considerable attention; however, information on the frictional behaviour of commercially available lingual brackets is limited. The aim of this study was to investigate the frictional resistance resulting from a combination of lingual orthodontic brackets (7th Generation, STb, Magic, and In-Ovation L) and stainless steel archwires at 0, 5, and 10 degrees of second-order angulation. Each bracket type (n = 30) was tested with three different sizes of archwires. Static and kinetic frictional forces were evaluated with a universal testing machine. Statistical analysis of the data was performed with non-parametric Kruskal-Wallis and Dunn's multiple comparison tests. All tested brackets showed higher frictional forces as the wire size and second-order angulation increased. The lowest friction was found with In-Ovation L brackets and 0.016 inch archwires at 0 degrees angulation, and the greatest friction with a combination of STb brackets and 0.017 × 0.025 inch archwires at 10 degrees angulation. For all combinations, Magic and In-Ovation L brackets showed lower frictional resistance when compared with 7th Generation and STb brackets. The slot width (occluso-gingival dimension) of the brackets, measured using the optics of a microhardness machine, showed that all brackets were oversized and that Magic brackets had the largest slot width. Surface roughness of the brackets investigated using atomic force microscopy and scanning electron microscopy, demonstrated that the 7th Generation brackets had the greatest surface roughness.

[Tracheobronchial injuries]. / Trakeobronsiyal yaralanmalar.

BACKGROUND: We aimed in this study to investigate and compare the diagnostic and therapeutic methods in tracheobronchial injuries. METHODS: Nine cases (7 male, 2 female) operated between 2003 and 2008 because of tracheobronchial injury were included in the study. The cause of tracheobronchial injury was trauma in 7 cases and postintubation laceration in 2 cases. The cases were evaluated in terms of age, sex, type of trauma, clinical findings, localization of injury, performed diagnostic and therapeutic methods, and results. RESULTS: The causes of tracheobronchial laceration were blunt trauma in 6 cases, penetrating trauma in 1 case and iatrogenic (postintubation) in 2 cases. Lacerations were in the trachea in 5 cases and at the bronchial level in 4 cases. Operations included right upper bilobectomy in 1 case, tracheal resection and end to end anastomosis in 1 case, end to end anastomosis in 3 cases, and primary repair in 4 cases. One case died during the operation and 1 case died postoperatively. CONCLUSION: In tracheobronchial injuries, early diagnosis and treatment are very important. The most useful method is bronchoscopy for determining the type and localization of the injury. In treatment, primary repair should be preferred over anatomical resections whenever possible.

Delayed Chest Closure for Oversized Lung Allograft in Lung Transplantation: a Retrospective Analysis from Turkey.

INTRODUCTION: The aim of this study was to evaluate the delayed chest closure (DCC) results in patients who underwent lung transplantation. METHODS: Sixty patients were evaluated retrospectively. Only bilateral lung transplantations and DCC for oversized lung allograft (OLA) were included in the study. Six patients who underwent single lung transplantation, four patients who underwent lobar transplantation, two patients who underwent retransplantation, and four patients who underwent DCC due to bleeding risk were excluded from the study. Forty-four patients were divided into groups as primary chest closure (PCC) (n=28) and DCC (n=16). Demographics, donor characteristics, and operative features and outcomes of the patients were compared. RESULTS: The mean age was 44.5 years. There was no significant difference between the demographics of the groups (P>0.05). The donor/recipient predicted total lung capacity ratio was significantly higher in the DCC group than in the PCC group (1.06 vs. 0.96, P=0.008). Extubation time (4.3 vs. 3.1 days, P=0.002) and intensive care unit length of stay (7.6 vs. 5.2 days, P=0.016) were significantly higher in the DCC group than in the PCC group. In the DCC group, postoperative wound infection was significantly higher than in the PCC group (18.6% vs. 0%, P=0.19). Median survival was 14 months in all patients and there was no significant difference in survival between the groups (16 vs. 13 months, P=0.300). CONCLUSION: DCC is a safe and effective method for the management of OLA in lung transplantation.

Intracardiac and pulmonary artery hydatidosis causing thromboembolic pulmonary hypertension.

Hydatidosis is a serious parasitic infection in endemic areas. A rare presentation is pulmonary arterial cysts causing thromboembolic pulmonary hypertension. We report the case of a young man who presented with clinical and radiological findings of thromboembolic pulmonary hypertension. The patient was found to have hydatid cysts in both pulmonary arteries and in the right ventricular outflow tract. To remove all cysts without causing rupture, anaphylactic shock or systemic emboli, placing the patient under cardiopulmonary arrest was necessary, and in the case of pulmonary arterial involvement, total circulatory arrest was necessary. The cysts were removed successfully, and the patient survived the operation. The patient is being followed up on albendazole treatment. Myocardial preservation and management of total circulatory arrest are the cornerstones of a successful surgical outcome.

Extended left pneumonectomy and left atrial reconstruction with autogenous graft in patient with T4 lung cancer.

In selective patients with T4 non-small cell lung cancer with the primary tumor invading the mediastinal organs, extended lung resection may contribute to long-term survival. Adequate patients should be given a chance for surgery if complete resection and required reconstruction can be achieved. In this article, we report a 63-year-old male patient with T4 non-small cell lung cancer invading the left atrium. In the patient, we performed an extended left pneumonectomy with en bloc partial resection of the left atrium wall (4×2.5 cm) where the defect was repaired with pericardial patch via cardiopulmonary bypass. No severe complication developed postoperatively. The patient who was given adjuvant chemotherapy has been living for more than 10 years without disease.

Effect of blood and saliva contamination on bond strength of brackets bonded with a protective liquid polish and a light-cured adhesive.

INTRODUCTION: The application of a polymer coating to the labial enamel tooth surface before bonding can help keep white spot lesions from forming. Previous studies evaluating the effects of blood and saliva contamination on the bond strengths of light-cured composites showed significant reductions in bond strength values. The purpose of this study was to investigate whether the bond strength of a light-cured system (Transbond XT, 3M Unitek, Puchheim, Germany) used with a liquid polish (BisCover, Bisco, Schaumburg, Ill) is affected by contamination with blood or saliva. METHODS: One hundred twenty permanent human premolars were randomly divided into 6 groups of 20. Various enamel surface conditions were studied: dry, blood contaminated, and saliva contaminated. A light-cured bonding system (Transbond XT) was used in all groups. The teeth in group 1 were bonded with Transbond XT. In the second group, BisCover polymeric resin polish was applied on the etched tooth surfaces before the brackets were bonded with Transbond XT resin. Comparison of the first and second groups showed no statistically significant difference. Groups 3 through 6 were bonded without Transbond XT. For groups 3 and 5, a layer of blood or saliva, respectively, was applied to the etched enamel followed by BisCover. In groups 4 and 6, blood or saliva, respectively, was applied on the light-cured BisCover. Shear forces were applied to the samples with a universal testing machine, and bond strengths were measured in megapascals. RESULTS: The protective liquid polish (BisCover) layer did not affect bond strength. CONCLUSIONS: Blood contamination on acid-etched surfaces affects bond strength more than saliva contamination. When a protective liquid polish (BisCover) is applied to the tooth surface, the effect of contamination by blood or saliva is prevented.

Effect of blood and saliva contamination on shear bond strength of brackets bonded with 4 adhesives.

INTRODUCTION: The purpose of this study was to assess the effect of blood and saliva contamination on the shear bond strength of 4 orthodontic adhesives. METHODS: Four adhesives (Transbond XT primer [3M Unitek, Monrovia, Calif], Transbond Plus self-etch primer [3M Unitek], Assure hydrophilic primer [Reliance, Itasca, Ill], and SmartBond cyanoacrylate [Gestenco, Gothenburg, Sweden]) were used to bond stainless steel maxillary central incisor brackets to 120 bovine permanent mandibular incisors. The teeth were randomly divided into 12 groups of 10 specimens, and each primer-adhesive combination was tested under different enamel conditions: dry, and blood and saliva contamination after priming. Shear forces were applied to the samples with a testing machine. Bond strengths were measured in megapascals. RESULTS: Statistical evaluations showed that the shear bond strength of the SmartBond cyanoacrylate adhesive group was significantly lower than all other groups; however, it was the only adhesive that was not affected by contamination. Saliva and blood contamination resulted in significant drops in shear bond strengths of the Transbond XT and Assure groups. Transbond Plus self-etch primer was also negatively affected by blood contamination, although it was suitable for bonding with saliva contamination.

Light curing the primer-beneficial when working in problem areas?

The purpose of this study was to investigate whether Transbond XT with MIP and Assure were affected by light curing the primers before contamination with blood or saliva. The study material consisted of 180 human premolars. The teeth were assigned into 12 groups of 15 specimens each. Metal brackets were bonded to each tooth under five different enamel surface conditions: dry, contaminated with blood or contaminated with saliva after primer application without light curing the primer, and contaminated with blood or contaminated with saliva after primer application with light curing the primer. The shear bond strengths of the two adhesive groups were not significantly different from each other within the same surface condition. There was no statistically significant difference between the groups bonded under dry conditions. On the other hand, curing the primer before adhesive application enhanced the bond strength in the contamination groups. Saliva and blood behaved similarly, showing higher bond strength values when the primer was light cured before contamination. However, they revealed bond strengths of different magnitudes because of the differences in the type and amount of inorganic and organic substances they contained. Under ideal conditions, light curing the primer did not introduce any advantages. However, curing the primer before contamination revealed higher bond strengths. To minimize the negative effect of contamination on bond strength, it would be appropriate for clinicians to light cure immediately after the application of the primer.

New protective polish effects on shear bond strength of brackets.

One of the solutions for the problem of white spot lesions has been the application of a polymer coating to the labial enamel surface. The aim of this study is to find out whether the liquid polish BisCover affects the bond strength of brackets bonded with a light-cured system (Transbond XT) and a no-mix system (Unite). Standard stainless steel premolar brackets were bonded to 100 permanent human premolars randomly divided into five equal groups. Two different enamel surface conditions were studied: dry and varnished with BisCover. For each enamel surface condition, two orthodontic adhesive systems were used: a light-cured system (Transbond XT) and a no-mix system (Unite). All teeth were conditioned with 37% phosphoric acid for 30 seconds, followed by thorough washing and drying. The teeth in groups 1 and 2 were bonded with Transbond XT and Unite, respectively. For groups 3, 4, and 5, a thin layer of BisCover was applied to the etched enamel with a brush and light cured for 15 seconds. In group 3, a thin layer of Transbond XT primer was applied, whereas in group 5, no additional primer was used on BisCover. In groups 3 and 5, the brackets were bonded with Transbond XT adhesive resin. Group 4 was bonded with no-mix Unite. Shear forces were applied to the samples by a Zwick Universal test machine, and bond strengths measured in megapascals. The results revealed that shear bond strengths of the groups did not differ significantly from each other.

The effect of myasthenia gravis as a prognostic factor in thymoma treatment.

OBJECTIVE: Thymoma is a standard epithelial tumor. Though it is rare, it constitutes 50% of anterior mediastinal masses. Variety of immunological diseases may accompany thymoma; however, myasthenia gravis (MG) is the most frequently associated paraneoplastic syndrome. Most effective treatment for thymoma is complete surgical resection. In this study, impact of MG on prognosis of thymoma cases was examined. METHODS: Records of 61 patients who underwent surgery with diagnosis of thymoma between January 2003 and September 2016 were retrospectively reviewed. All cases were analyzed for data related to age, gender, complaint, localization of lesion, surgical procedure, histopathological diagnosis, stage, MG, and long-term follow-up results. RESULTS: Total of 58 cases were included in the study. Of those, 37 patients were male and 21 were female. Mean age was 48 years. While 24 cases of thymoma were accompanied by MG, 34 cases were not. Duration of follow-up ranged from 1 month to 155 months. CONCLUSION: It was found that in group with MG, 5-year survival rate was 87.5% while it was 82.4% in group without MG. Despite longer duration of survival in group of thymoma associated with MG, there was no significant statistical difference between groups (p=0.311).

Delayed chest closure for oversized lung allograft in lung transplantation: a retrospective analysis from turkey

Abstract Introduction: The aim of this study was to evaluate the delayed chest closure (DCC) results in patients who underwent lung transplantation. Methods: Sixty patients were evaluated retrospectively. Only bilateral lung transplantations and DCC for oversized lung allograft (OLA) were included in the study. Six patients who underwent single lung transplantation, four patients who underwent lobar transplantation, two patients who underwent retransplantation, and four patients who underwent DCC due to bleeding risk were excluded from the study. Forty-four patients were divided into groups as primary chest closure (PCC) (n=28) and DCC (n=16). Demographics, donor characteristics, and operative features and outcomes of the patients were compared. Results: The mean age was 44.5 years. There was no significant difference between the demographics of the groups (P>0.05). The donor/recipient predicted total lung capacity ratio was significantly higher in the DCC group than in the PCC group (1.06 vs. 0.96, P=0.008). Extubation time (4.3 vs. 3.1 days, P=0.002) and intensive care unit length of stay (7.6 vs. 5.2 days, P=0.016) were significantly higher in the DCC group than in the PCC group. In the DCC group, postoperative wound infection was significantly higher than in the PCC group (18.6% vs. 0%, P=0.19). Median survival was 14 months in all patients and there was no significant difference in survival between the groups (16 vs. 13 months, P=0.300). Conclusion: DCC is a safe and effective method for the management of OLA in lung transplantation.

Thoracic Traumas: A Single-Center Experience.

OBJECTIVES: Trauma is currently among the most important health problems resulting in mortality. Approximately 25% of trauma-related deaths are associated with thoracic trauma. In the present study, morbidity and mortality rates and interventions performed in patients who had been treated as inpatients in Dr. Siyami Ersek Thoracic and Cardiovascular Surgery hospital after trauma were aimed to be evaluated. MATERIAL AND METHODS: In our study, 404 patients who were treated as inpatients because of thoracic trauma between January 2005 and December 2008 were retrospectively evaluated. RESULTS: The rates of blunt and penetrating trauma were 39.6% and 60.4%, respectively. In the study, 115 (28.4%) patients were noted to have pneumothorax, 99 (24.5%) had hemothorax, and 57 (14.1%) had hemopneumothorax. While tube thoracostomy was sufficient for treatment in approximately 80% of the patients, major surgical interventions were performed in 12.6% of the patients. Mortality rate was found to be 2.2%. CONCLUSION: In patients with chest trauma, necessary interventions should be started at the time of the event, and the time from trauma to arriving at the emergency department should be made the best of. Mortality and morbidity rates in thoracic trauma cases may be reduced by timely interventions and effective intensive care monitoring.

Intrathoracic giant solitary fibrous tumor.

BACKGROUND: Solitary fibrous tumor of the pleura is a rare, usually benign, and slow-growing neoplasm. Complete surgical resection for giant tumor of the pleura is challenging because of poor exposure and a large blood supply. We report the case of a giant hypervascular fibrous tumor that filled nearly the entire left hemithorax and anterior mediastinum, and its preoperative management. CASE REPORT: A 59-year-old woman presented to us with exertional dyspnea and chest pain. A chest radiograph showed the right hemithorax completely opaque and a mediastinal shift to the left hemithorax. A tomography scan of the thorax showed a giant mass that almost completely filled the right hemithorax and compressed the mediastinum to the left. Because of excessive bleeding during dissection, the operation was terminated after a biopsy specimen was obtained. The biopsy was diagnosed as a benign fibrous tumour. A thoracic computed tomography angiogram showed that the mass was supplied by multiple intercostal arteries as well as an aberrant artery that branches off the celiac trunk in the subdiaphragmatic region. Due to the many arteries that needed to be embolized, the final decision was to control the bleeding following resection by inducing total circulatory arrest with the help of cardiopulmonary bypass. The bleeding could not be controlled under cardiopulmonary bypass and the patient's death was confirmed. CONCLUSIONS: We report this case to emphasize the necessity of preoperative embolization; the use of cardiopulmonary bypass and total circulatory arrest is not a valid alternative method to control the bleeding.